1. Health and Human Services COWLITZ INDIAN TRIBE

2. Policy and Budgeting Set by Tribal Council and Health Board.  Bill Iyall, Chairman, Cowlitz Indian Tribe  Cassy Reck, Health Board Chair  Jim Sherrill, HHS Director  Steve Kutz, Deputy HHS Director  Cowlitz Compacted for Title V Self Governance in 2011. Previously, Title I HHS ADMINISTRATION

3. LongviewSeattleVancouverToledo Medical Clinic2004 New facility 2011 --- Mental Health – Outpatient20052010 - Adult Alcohol/CD - Outpatient2003-2006- Youth Alcohol/CD – Outpatient20082012-- Contract Health Services2002CHSDA Counties Include: Clark, Cowlitz, Columbia (OR), Wahkiakum, Skamania, Lewis, Thurston, Pierce, King, Kittitas Indian Child Welfare2009Children and Family services All Washington State Sexual Assault Advocacy2005- 2006- Domestic Violence Advocacy2007- - Vocational Rehabilitation20042006 Elders Program2002 -- COWLITZ HHS PROGRAMS I H S Non-IHS

4.  Redesigned CHS Dollars  Primary Care, Behavioral Health  Opened Clinic in Longview, 2004 with One Nurse Practitioner  Current Providers: 1 FTE Physician.3 FTE Physician.3 FTE Nurse Practitioner 2 FTE MH Therapists 2 FTE Psychiatric Nurse Practitioners.1 FTE Registered Dietician 1 FTE CHR (new position at Cowlitz). MEDICAL CLINIC

5.  New facility opened September, 2011. Construction funded by Tribal, IHS/SAP, and HUD dollars  See all enrolled AI/AN, descendants, some family and employees with billable resource.  300 + Primary Care Visits per month. 50 + Behavioral Health Visits  About 50% of patients from 150+ tribes.  Ongoing implementation of EHR. MEDICAL CLINIC

6.  Started with.5 FTE Psych Nurse in Longview, 2006.  Hired 1 FTE Psych Nurse in Longview 2008.  Added 1 FTE Psych Nurse in Vancouver, 2009.  Added Youth and Family Therapy in Seattle, 2010.  Currently recruiting for 2 FTE therapists and psych nurse for Longview. MENTAL HEALTH

7.  Longview and Vancouver Psych Nurses provide medication management and therapy.  Seattle therapists work with local school districts to provide services for AI/AN youth and families.  Seattle therapists conduct several hundred visits per/month.  Mental Health Programs are also utilizing EHR. MENTAL HEALTH

8.  Began 2004 with 1 counselor in Longview  Total of 8 adult groups in Longview and Vancouver  WA State Certified  CARF Accredited  Funded by billing revenues ADULT ALCOHOL/CD – OUTPATIENT

9.  Began summer, 2007, in Longview.  Currently, youth served are primarily non-Native.  Working on MOU with School Districts in King County to provide services to AI/AN youth in coordination with current mental health program.  Considering adding program in Vancouver, WA.  Funded by billing revenues.  CARF Accredited. YOUTH ALCOHOL/CD – OUTPATIENT

10.  Provides Congregate and Home Delivered Meals to AI/AN in Lewis and Cowlitz Counties.  Provides Transportation, Caregiver Support, Cultural Activities, Trips and More.  Considering alternatives for Home and Community Based Services as allowed by IHCIA.  Funded through federal Agency on Aging. ELDERS PROGRAM

11.  Provides Job Preparedness and Search Support for enrolled members of federally and state recognized tribes from, Clark, Skamania, Cowlitz, Wahkiakum, and Lewis Counties.  Individuals must have a documented disability. (Physical, Mental, Substance, Etc.) VOCATIONAL REHABILITATION  Helps dozens of AI/AN annually to attain and maintain sustainable employment.  CARF Accredited. Only Tribally-operated program in the country with this distinction.  Funded through the Department of Education, Rehabilitation Services Administration.

12.  Staff one ICW Social Worker to manage cases across the state.  Case load ranges between 15-30 at any given time.  Funded by WA DSHS Contract. INDIAN CHILD WELFARE Kids Camp, 2010

13.  Serves Cowlitz Indian Tribal Members in the CHSDA.  CHSDA includes: Clark, Cowlitz, Skamania, Wahkiakum, Columbia (OR), Lewis, Thurston, Pierce, King, Kittitas.  Tribe has over 3700 members (About 1800 in CHSDA) No Reservation.  Following WA counties have 300+ members: Clark, Cowlitz, Thurston, Pierce, King.  Tribal Members must utilize any I/T/U within 60 miles of their home for primary care in order to be eligible. CONTRACT HEALTH SERVICES

14.  Provides advocacy services for self- identified AI/AN who have been affected by sexual assault, domestic violence, dating violence or stalking.  Serves Clark, Cowlitz, and South Lewis Counties.  Services may include: legal advocacy, education, transitional housing, clothing, transportation, other financial aid, etc.  Programs are funded through Washington State’s Office of Crime Victims Advocacy and the Department of Justice. ADVOCACY SERVICES “PATHWAYS TO HEALING” PROGRAM

15.  Canoe Family SUPPORT FOR CULTURAL ACTIVITIES

16.  Canoe Family SUPPORT FOR CULTURAL ACTIVITIES

17. SUPPORT FOR YOUTH PROGRAMS